Dheeraj Makkar

Epidermal melanocyte deficit is the basis of Vitiligo. It is a prolonged condition that may be inherited or acquired. Vitiligo affects 1-2 percent of the global population of all races. Several processes have been hypothesized for the breakdown of melanocytes in Vitiligo. These include genetic, autoimmune, oxidative stress, inflammatory mediator production, and melanocyte detachment processes. Vitamin D suppresses UVB-induced apoptosis in keratinocytes and melanocytes by reducing IL-6, IL-8, TNF-a, and TNF-c production. It reduces the autoimmune linked to Vitiligo. We conducted a case-control study in which we compared the level of Vitamin D in patients with Vitiligo and healthy cases. We confirmed our diagnosis with biopsy and utilized the Elisa method to assess the level of Vitamin D. The concentrations of Vitamin D in individuals with Vitiligo were much lower than in controls; however, we did not find a significant effect of vitamin D deficiency on the progression of Vitiligo lesions. Therefore we conclude that Vitamin D is involved in the genesis of Vitiligo, and replenishing the levels may help the patient recover faster. Keywords: Vitiligo, Vitamin D, Melanocytes, Keratinocytes

Bone is a dense, mineral-rich tissue with organic components. Implants such as plates and nails are used to reconstruct fractures. In orthopedic surgery, broad-spectrum of drills ranges from pneumatic to battery-operated to electric drills. Each drill has its own set of benefits and drawbacks.Though the standard of care, the orthopedic battery drill, and pneumatic drills are costly, the expense of maintenance is too high. Orthopedic surgeons frequently employ alternatives such as the Bosch battery drill and a corded electric drill in developing nations. These drills are inexpensive, but they cannot be used for reaming. Furthermore, some models have a constant speed, making them difficult to utilize for reaming.We offer drill modifications to control the speed and use it for reaming. The literature has abundant evidence to dismiss misconceptions concerning electric drill overheating and bone thermal necrosis. There are multiple scientifically documented methods for effectively sterilizing an electric drill. Due to its affordability and ease of maintenance, our innovations, such as speed control and drill cannulation, enable us to adopt it for most trauma surgeries, particularly in developing nations. Keywords: Electric Drill, Reaming, Battery Drill, Bosch

Monkeypox virus was named so because of its detection in monkeys in 1958. It belongs to the same family as smallpox and chickenpox viruses. There had been numerous outbreaks of this malady initially in the African continent and other parts of the world. The simultaneous spread in nineteen countries in 2022 has raised some serious concerns.Monkeypox is no more a rare disease and has the potential for bioweapon use. We discuss the various ways to prevent its spread, treatment options available, diagnosis, and differentiation from other closely related diseases. We also discuss if the present outbreak could be a bioattack or if this disease is here to stay.The literature suggests that we can effectively manage Monkeypox because of the availability of drugs and vaccination against smallpox. There is also a need for active surveillance against the new resistant recombinant viral strains. The possibility of this outbreak being a bioattack seems remote, although there are questions about the transmission which still need to be answered.   Keywords: Monkeypox, Prevention, Treatment, Endemic, Transmission

Rhabdomyosarcoma (RMS) is the commonest soft sarcoma in kids, with alveolar and embryonal variants distinguishable by histopathology and, more significantly, molecular biology. RMS occurs intermittently in a substantial proportion of cases without a predisposing condition. Nevertheless, it is well established that certain hereditary factors enhance the likelihood of developing RMS. Beckwith–Wiedemann syndrome, Gorlin syndrome, Costello, NF1, and Li Fraumeni syndromes are some of them. These syndromes present with RMS during childhood.A 47-year-old female with NF 1 discovered a lump in her right forearm one year prior to presentation. When the patient noticed ulceration on the swelling, she sought medical attention. A tumor was detected in the center of the right forearm via MRI, and it was suspected to be a cystic or myxoid soft-tissue tumor, rhabdomyosarcoma or a peripheral neural tumor. We classified the tumor as stage 4 due to axillary lymph node involvement and lung metastasis. Histopathology confirmed rhabdomyosarcoma.   The patient then received radiotherapy and chemotherapy, and her tumor went into remission.After confirming NF1 syndrome, we advise patients to adhere to the standard cancer screening protocol. The screening would assist in the earlier diagnosis of tumors, leading to a reduction in complications. Keywords: Rhabdomyosarcoma, Neurofibromatosis 1, Histopathology, Gorlin syndrome.

Background: Epidermoid cysts are cutaneous cysts frequently observed among farmers, factory workers, carpenters, and tailors due to their occupations' predilection for repetitive minor hand trauma. Case Presentation: A 66-year-old male laborer presented to our hospital with a swelling on the palmar aspect of his right middle finger. The swelling was accompanied by pain and an inability to work over the previous four months. A 2.5 cm × 2.5 cm smooth, tender, immobile, non-compressible hard swelling was detected just above the middle phalanx during the clinical examination on the volar aspect of the right middle finger. The diagnosis was confirmed by histopathology after excision. The patient's range of motion improved significantly following surgery, and his pain subsided. Conclusion: We present a novel location for an epidermal inclusion cyst and the importance of histopathologic evaluation in this case. Additionally, we emphasize the significance of extensively checking the cyst's epithelium to guarantee complete capsule removal and rule out any additional pathology. Keywords: Epidermoid Cyst, Keratin, Histopathology, Middle phalanx, Hand

Background: Osteochondral lesions of the talus typically present as cartilage denudation after trauma or as cystic lesions in the bone with intact cartilage. Osteochondral fractures require an anterograde approach for treatment. Retrograde drilling and packing with a bone graft can treat lesions with intact cartilage. Because subchondral lesions involve the posterior aspect of the talar dome, these lesions can be difficult to localize with an image intensifier. Description of Technique: We describe a method in which ankle arthroscopy is used to visualize a subchondral lesion, along with an ACL jig to target the lesion precisely. Materials and Methods: We performed retrograde drilling in two patients: a 29-year-old man and a 34-year-old man. Each patient presented with a subchondral cystic lesion in the posteromedial aspect of the talus. We treated both patients by modifying the standard technique for retrograde drilling. Patients were evaluated before and after surgery using the AOFAS score and X-rays of the ankle joint. Results: The X-rays taken at the 3-month follow-up showed a well-maintained contour of the talar dome with complete incorporation of the bone graft. The AOFAS scores for both patients were greater than 90, excellent per the Saxena and Eakin criteria. Conclusions: This method decreases radiation exposure, invasiveness, and surgical time of the procedure.   Keywords: Osteochondral lesions, ACL jig, Talus, Retrograde drilling.

Introduction: Shoulder rotator cuff injuries are prevalent among the elderly. Rotator cuff tears, like osteoarthritis, are an inevitable aspect of aging. The only difference is that soft tissue rather than cartilage is involved in the degenerative process. We hypothesized that exogenous systemic administration of recombinant growth hormone would increase the concentration of various growth factors involved in rotator cuff healing, Materials and Methods: Forty-eight Sprague-Dawley rats (Charles River, male, 400-450 g) were subjected to unilateral detachment repair of the supraspinatus and infraspinatus tendons at Konkuk University per Institutional Animal Care Committee recommendations. The rats were divided in two groups one were injected with recombinant GH and controls. Initially an artificial rotator cuff tear was created and later repaired with vicryl 4-0. The animals were sacrificed at 1, 3, 6, and 12 weeks. The rotator cuff was removed enmasse. Both groups were compared histologically and immunologically for collagen 1 and 3. Statistical analysis between both the groups was done using SPSS software. Conclusion: The recombinant GH helped in early healing of rotator cuff tears if injected systemically. More clinical trials need to be done before the exact dose can be determined for humans. Keywords: Rotator Cuff, Recombinant, Growth Hormone, Collagen 1 and 3

Introduction: Pain, swelling, and stiffness in the knee joint due to degenerative knee disease (osteoarthritis in the knee, which affects the joint lining and menisci) are among the most prevalent causes of difficulty walking. Damage to the cartilage in the knee joint leads to increased friction and, in extreme situations, the development of new bone. It is widely prevalent in our country due to predominance of kneeling and other cultural habits. Purpose of the Study: We hypothesized that if we could remove the debris of the cartilage and other degenerative tissue through knee lavage it would relieve the joint pain and stiffness. We further decided to augment this treatment with intra articular methyl prednisolone 80 mg to decrease the inflammation of the synovium and provide a prolonged relief. Materials and Methods: All patients will undergo arthroscopic knee lavage with 3000 milliliters of ringer lactate solution under sterile conditions in the operating room.As a local anesthetic, 10 milliliter of lignocaine 2% was used. Eighty milligrams of methyl prednisolone were injected through the arthroscopic cannula at the conclusion of the procedure. The patient was sent home with stringent activity restrictions for only 24 hours. For seven days following surgery, patients were prescribed a moderate analgesic and an antibiotic. After a week, the bandage was removed and a band-aid was affixed for the remaining five days. At 1 month, 3 months, and 6 months, patients were contacted for evaluation and the pre operative and post operative pain scales were compared. Results: Patients with Kellgren and Lawrence grade 3 osteoarthritis reported a statistically significant improvement in pain relief from pre- to post-operative VAS scores (p 0.05) after three months, and 67 percent reported good or excellent results after six months. Conclusion: Knee lavage with methyl prednisolone 80mg under local anesthesia is an effective treatment option for patients with grades 1, 2, and 3 osteoarthritis who are unable to undergo surgery for economic or medical reasons or who have a substantial NSAIDS requirement. Keywords: Osteoarthritis, Knee lavage, Methyl prednisolone, Arthroscopy

The present investigation aims to examine the impact of the mindfulness-based stress reduction program (MBSR) and mindful practice on individuals diagnosed with cancer, drawing upon the extant literature. The MBSR program typically spans over a duration of eight weeks and involves a structured and intensive approach to training individuals in mindfulness meditation techniques. The present investigation examined the Pubmed search engine and identified a total of 1919 studies through the utilization of specific keywords. The scope of the search was narrowed down to encompass solely studies and trials that incorporated mindfulness practices. Qualitative intervention methods, reviews, observational studies, metanalysis, yoga, and dietary modifications were explicitly excluded from consideration. We additionally incorporated investigations with an impact factor equal to or greater than 10. The present study involved the analysis and review of nine studies that have been assigned an impact factor of ten or higher. Participants displayed more serenity; they felt more vibrant, balanced, upbeat, pleased, and emotionally strong. Their enhanced level of acceptance, presence, and perceptiveness in their interpersonal connections resulted in an elevated standard of living. Keywords: Mindfulness, Stress reduction, Anxiety, Cancer

The coracoid process is a unique anatomical structure that extends anteriorly from the scapula in a hook-shaped manner, with variations in size, shape, and orientation among individuals. Although uncommon, fractures of the coracoid process may occur and can be difficult to detect on regular X-rays due to their morphology. In this case study, we report on a 46-year-old daily wage worker who presented to the emergency department with left shoulder pain and limited mobility following a traffic collision. Initial X-rays revealed only an acromioclavicular joint dislocation, but further evaluation with a CT scan confirmed a coracoid fracture with minor displacement. Despite the concurrent dislocation, we opted for conservative treatment, and the fracture had completely healed after six weeks of physical therapy. The use of specific shoulder X-ray views, such as the scapula Y or axillary view is recommended to rule out coracoid fractures, while CT scans are considered the gold standard for diagnosis. Treatment options for coracoid fractures may range from non-operative management to surgical repair, depending on the type of fracture. Our case report highlights a rare occurrence of a coracoid process fracture with acromioclavicular joint dislocation treated conservatively.   Keywords: Coracoid, Isolated, Fracture, CT scan, Scapular Y

Early termination of pregnancy (ETP) is a common procedure, with surgical intervention being the prevailing method. However, it carries inherent risks. This case report describes a 27-year-old woman with a history of left hip surgery who sought pregnancy termination. Due to her limited hip abduction, positioning her for surgery posed challenges. The patient underwent dilatation and curettage after cervical preparation with misoprostol and vaginal chlorhexidine solution. The procedure was modified to accommodate her hip limitations, using a straight table without conventional leg holders or stirrups. Successful pregnancy elimination was confirmed, and the patient remained uneventful during follow-up. This case report highlights the need for alternative approaches for ETP in patients with hip ailments. The modified procedure offers advantages such as simplicity, reduced equipment requirements, easy post-anesthesia positioning, and avoidance of common peroneal nerve palsy. Further research is warranted to validate these findings and extend them to a broader patient population, potentially improving safety and effectiveness in surgical interventions for this specific group.   Keywords: Termination, Lithotomy, Dilatation and Curettage, Misoprostol

This case report focuses on the management and treatment of a ten-year-old boy who suffered extensive hand injuries from a live firecracker explosion during Diwali celebrations. The purpose of the report is to highlight the importance of caution when handling fireworks and to present the approach taken in managing the patient's injuries.The patient underwent a comprehensive assessment, and a treatment plan was formulated. The plan included exploration and debridement, conservative management, thumb and index finger fixation, posterior interosseous flap surgery, and wrist stabilization with JESS. Additionally, a contracture release procedure was performed to address finger contracture. The patient received physical rehabilitation for hand functionality restoration.The case report emphasizes the significance of handling fireworks with care and the need for immediate medical attention in the event of injuries. The successful outcome achieved through the implemented treatment plan underscores the importance of prompt and appropriate management in fireworks-related accidents.   Keywords: Fire crackers, Debridement, Flap, JESS.